” Over the past, you know, 10, 15, 20 years and well before that, it’s been necessary to get doctors from overseas.

But what we’ve seen now is that we’ve got a reasonable oversupply of GPs and other specialists in inner-metropolitan Australia, and I think what we need to work harder on is investing in incentives to get doctors to work in rural areas.

The current system is not addressing the stated means of these regulations and that’s to close the gap between the health outcomes of rural Australians and those living in its cities.”

AMA president ­Michael Gannon see Interview below

” While there are now enough Australian-trained medical graduates being generated through our medical training system, there remains a significant maldistribution of doctors — those doctors with the right skills are not necessarily going on to work in the rural and remote communities that need them most.

We are pleased that the Federal Government has set the development and implementation of the Framework as a key priority for the newly-announced role of Rural Health Commissioner. We look forward to working closely with the Commissioner and the Government to make it a reality, and to deliver to the bush the next generation of Australian-trained doctors.”

RDAA President, Dr Ewen McPhee

” The Australian Medical ­Association and the Rural Doctors Association welcomed the move to restrict visas but it prompted calls for greater incentives and support for local doctors, inflaming tensions over the Medicare freeze and public hospital funding.”

Sean Parnell The Australian 8 August see below

With thousands of foreign doctors currently in the system, and an increasing number of local graduates, the department has ­secretly argued that Australian-trained doctors will struggle to find jobs if the immigration pathways are not closed.

The department wants 41 health roles — including general practitioners, resident medical ­officers, surgeons and anaesthetists — to be removed from the Skilled Occupations List in the hope that Australian doctors will fill areas of need, particularly in remote areas.

While its recommendations were not accepted by the Turnbull government in visa changes made before the election, they will be revisited within months and Health Minister Sussan Ley has foreshadowed broader workforce reforms next year.

The Australian Medical ­Association and the Rural Doctors Association welcomed the move to restrict visas but it prompted calls for greater incentives and support for local doctors, inflaming tensions over the Medicare freeze and public hospital funding. After a misguided ­attempt to cut costs by restricting doctor numbers, successive governments funded new medical schools and increased the number of graduates to the point where training places and internships are now hard to secure.

The Health Department, in its unpublished submission to the latest review of the Skilled Occupations List, sees a wave of ­Australian-trained doctors coming into the system and fears the public investment in their skills will be squandered.

Health officials want to bring long-simmering workforce issues to a head to see whether market forces need to be complemented by new government initiatives.

“Australia’s health system has a complex division of funding, policy and operational responsibilities,” says the department’s submission, released to The Australian under Freedom of Information laws. “It is also currently highly ­reliant on international health professionals, in an environment of increasing concerns around ethical recruitment of those workers.

“Immigration is often used as a short-term demand management strategy and it continues to be poorly co-ordinated … Over a longer planning ­horizon, better management of migration pathways for international health professionals must occur in combination with all commonwealth departments … and the analysis must include evolving training and reform strategies.”

Earlier this year, the department urged the Department of Education and Training, in considering the Skilled Occupations List for 2016-17, to “remove all medical occupations”, including general practitioners, resident medical officers, surgeons and ­anaesthetists.

The Education ­Department advises the Immigration Minister each year on the composition of the list. At the end of March, according to Immigration Department figures, there were 2155 general practitioners and 1562 resident medical officers in Australia on visas. It was unclear last night why the commonwealth opted to delay the changes recommended by the Health Department.

The only occupations it succeeded in having removed were dental hygienists, prosthetists, technicians and therapists. Psychotherapists remain on the Skilled Occupations List despite the department arguing the term is problematic because “anyone can call themselves a psychotherapist”.

Immigration Minister Peter Dutton, the previous health minister, did not respond to requests for comment yesterday, nor did the Education Department.

Rural Doctors Association of Australia president Ewen ­McPhee welcomed the proposal, saying there was a need to encourage and support local graduates into areas and specialties of need, rather than rely on short-term visas. AMA president ­Michael Gannon said the immigration pathway had failed to ­address regional and rural workforce inequities. “If anyone was to suggest we need to keep these pathways open to get doctors in the bush I’d tell them that’s not currently happening,” Dr Gannon said.

Rural doctors support visa considerations; urge better supports to boost rural medical workforce

The Rural Doctors Association of Australia (RDAA) says calls for GPs to be removed from the skilled occupations list for visas has to be part of Australia’s future medical workforce considerations — but it has added that better supports, incentives and a

National Rural Generalist Framework are urgently required to get more Australian-trained doctors to the rural and remote communities that need them.

The Australian newspaper has reported today that, in an unpublished submission to the latest review of the Skilled Occupations List, the Federal Health Department has urged the removal of 41 health roles, including GPs, from the skilled occupations list for visas.

If implemented, the change would mean that International Medical Graduates (IMGs) would no longer be able to come to Australia under the visa class to work as a doctor.

“International medical graduates have made, and continue to make, an immensely significant contribution as valued local doctors in many rural and remote communities” RDAA President, Dr Ewen McPhee, said.

“In many cases, medical services in these communities would no longer be available if dedicated and long-serving IMGs were not there to keep them going.

“For this, we owe past and present IMGs a huge debt of gratitude.

“But it is not right that we should continue to rely on enticing more and more IMGs from their own countries to prop up the Australian health system, when we now have enough

Australian-trained medical graduates to meet demand — particularly given that many IMGs come from poor countries with struggling medical systems.

“What we do need, however, are a range of better supports and incentives to entice more Australian-trained medical graduates with the advanced skills needed to work in rural and remote areas.

“While there are now enough Australian-trained medical graduates being generated through our medical training system, there remains a significant maldistribution of doctors — those doctors with the right skills are not necessarily going on to work in the rural and remote communities that need them most.

“In addition to better supports and incentives, RDAA has been a strong advocate for a National Rural Generalist Framework and associated training program that would provide medical students and young doctors with a seamless and dedicated pathway from medical school and the intern years through to work as a rural generalist doctor — while also providing those on the Program with training in the advanced skills needed for rural practice.

“These include procedural skills in obstetrics, anaesthetics, emergency medicine and general surgery, and non-procedural skills like advanced mental healthcare and Indigenous healthcare.

“We are pleased that the Federal Government has set the development and implementation of the Framework as a key priority for the newly-announced role of Rural Health Commissioner. We look forward to working closely with the Commissioner and the Government to make it a reality, and to deliver to the bush the next generation of Australian-trained doctors.”

Transcript: AMA President Dr Michael Gannon, 774 ABC Melbourne, 9 August 2016

Subjects: Overseas Trained Doctors

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SALLY WARHAFT: Right now we’ve got the President of the Australian Medical Association on the line because we’ve been hearing for years about the shortage of local doctors in Australia and we’ve seen all kinds of schemes to lure foreign doctors to set up their lives and practices here. Well it seems the problem is fixed and there are reports of a plan to stop granting visas so freely to overseas doctors. Dr Michael Gannon, President of the AMA, is on the line. Thanks for joining us.

MICHAEL GANNON: Good morning. How are you?

SALLY WARHAFT: I’m fine, thank you, but can you tell us about what the current situation is with doctors here because I thought there was a chronic shortage?

MICHAEL GANNON: Well, the story’s a little bit more complicated than Sean Parnell’s made out in the story in today’s Australian. But certainly this does signal the importance of having a conversation on what we need. The first thing I’d like to say is that we really value overseas-trained doctors, international medical graduates; they’re a big part of our system. They’re amongst my friends and closest colleagues, and they’ve been a really important part of the jigsaw in a country that underinvested in medical students for a long period of time. And over the past, you know, 10, 15, 20 years and well before that, it’s been necessary to get doctors from overseas. But what we’ve seen now is that we’ve got a reasonable oversupply of GPs and other specialists in inner-metropolitan Australia, and I think what we need to work harder on is investing in incentives to get doctors to work in rural areas. The current system is not addressing the stated means of these regulations and that’s to close the gap between the health outcomes of rural Australians and those living in its cities.

SALLY WARHAFT: You expressed, of course, the importance and the benefits that foreign doctors bring and medicine is an incredibly collegial profession too. And yet the AMA are supporting, at least it’s reported, a slow down on those foreign visas. What’s your position on that?

MICHAEL GANNON: What I’d like to see is just smarter arrangements rather than just the blunt legislative regulations that exist through the Immigration Department at the moment. I think what everyone would like to see is if there’s a unique or special talent from a doctor trained overseas that we can still get those people in. But surely the stated intention of these mechanisms is to get doctors to where they’re really needed in Australia. There’s the moral questions about whether we should be taking doctors trained from other countries because often they are coming from Second and Third World countries. So there’s that question…

SALLY WARHAFT: [Talks over] Although, I mean, I’ve always assumed that there’s a measure there and you’re either above that line or you’re below it. And we know, I mean for example, some of the most brilliant and well-trained doctors in the world come from countries like India.

MICHAEL GANNON: I’m not for one minute questioning the quality of medical education. I’m actually questioning how appropriate it is to take doctors from countries that have their own problems…

SALLY WARHAFT: [Talks over] That need their doctors. Right.

MICHAEL GANNON: Yeah. So I think that I once read that – forgive my numbers – if an Australian town of 4,000 people takes a doctor from South Africa, they were looking after 14,000 people, who then take a doctor from Uganda who might look after 24,000 people. So I think that we’ve got to look at that element of it. And we just have to look at a system which is not delivering on its stated intention, which is to get doctors where they’re really needed – often we’re talking about procedural GPs in rural areas – often what we’re doing is filling up corporate clinics in the middle of our cities. Now that’s not the intention of these regulations.

SALLY WARHAFT: So that problem of getting GPs to go to rural, and let alone remote areas, obviously isn’t fixed. I’m sort of surprised, Michael Gannon, that the AMA or the Government have not been able to create a- well, you think there’d be a charming lifestyle to offer, you know, the country practice. Why are doctors so reluctant to move to the country?

MICHAEL GANNON: Well I think that, you know, so many of my colleagues that work in rural areas will talk about very, very rewarding professional careers. And we know that. The studies exist to show that if you give medical students positive experiences when they’re training, if you give junior doctors positive experiences when they’re training, they’re far more likely to go and work there. So that’s where we’d like to see investment. We’d like to see investment in really simple things like making people feel safe. You’ll know that a majority of medical students now are young women, and we want them to have really positive experience, so accommodation where they feel safe, positive experiences where they’re mentored by senior doctors. If we provide those experiences, people are more likely to go and work in the country when they make their career.

SALLY WARHAFT: Well, it’s a really fascinating conversation and I appreciate you explaining it in a lot more detail to us. I really appreciate it.

MICHAEL GANNON: That’s a pleasure.

SALLY WARHAFT: Dr Michael Gannon, President of the Australian Medical Association.